One of the most unsettling aspects of being a therapist has to be dealing with people you know are sociopaths or dangerous in other ways.
AskReddit threw an intriguing question out there for therapists to answer: how did they realize they were treating a sociopath?
“Psych nurse here.
Patient I gained a lot of trust with told me about this person he and two others tortured almost to death. I knew the case because it made the news. He went to jail for it. Went in to details about the torture. It included making hundreds of cuts to the persons body and giving them an acidic bath.
This guy was in our ward for about a month (continually threatening suicide if he was discharged). .
Thing is he stood trial as a minor and threw his mates under the his, claiming they were the instigators and he simply went along with it. They are still in jail.”
2. Psych unit
“I worked in a locked inpatient psychiatric unit for 5 years. I saw many things that scared me but the most bone- chilling patient I ever worked with was a handsome, charming 35 year old man we will call Mark.
On our unit, if you told your nurse you were actively suicidal, you were placed on a 1:1 meaning you had a staff person assigned to you at all times to be in any room you were in to make sure you didn’t hurt yourself. Mark nonchalantly came up to his nurse this particular day and stated he was suicidal and needed assigned a staff personal. Even though we knew (or so we thought bc you can’t be 100%) that he was lying, we had to provide him with a 1:1. I was the only available staff person and was therefore assigned to him. He asked me to walk “laps” on the unit with him. I said sure.
As we walked he asked seemingly meaningless questions about things like my favorite food or holidays I enjoy. I am always cautious about giving out information and felt his questions were harmless. About an hour into our walking he commented that He gathered I care deeply for others. Then took his head and smashed it through a glass window. Blood gushed from his face and glass was stuck all over his head. We had to transport him by ambulance to our emergency department.
Two days later he returned back to our unit, medically/ physically cleared. Upon coming back he came up to me to apologize for “scaring me”, winked, and walked away. I fully believe he caused pain to himself to put that ever terrible visual in my head and scare me into knowing that if he could so easily hurt himself, he could do the same for others.”
3. Great kid…
“Great kid during the day, tormented his foster siblings and videotaped it at night. Loved being the “good kid” in the house during the day and “didn’t understand why Jimmy would scream and hit so much.” Meanwhile Jimmy” was his target at night but wasn’t verbal and couldn’t tell anyone. Sociopath was always kind to the verbal child so only Jimmy was prey. In front of the foster parents, Sociopath seemed like a model teen. Finally a video surfaced through sheer dumb luck and now Sociopath is in jail. No one believed it until they saw the video. He’s handsome, charming, and will ruin lives because his youthful offender status means he won’t have a criminal record.”
4. A terrible mistake
“My dad’s a (now semi-retired) psychologist. Back in the 90’s, he was working as the director of psychology for a large housing and treatment facility for the severely mentally disabled. He wanted to get into doing some therapy sessions for non-disabled folks on the side, just to mix things up and stretch his professional wings a little. Our house had a home office “wing” with a separate entrance, so he decided to start seeing a few patients on the weekends.
This plan lasted about three weeks before he realized that he’d made a terrible mistake.
One of his patients, a very large gentleman, began visibly melting down during a session, pacing around the office and acting increasingly erratic. My dad’s thoughts turned to the fact that his wife and three kids were now in the same house with a big dude who was clearly unstable. He slowly positioned himself by the door in case the guy tried to bolt for it. The guy noticed this, pulled out a gun, and said, “Don’t worry, if I wanted to hurt you or myself, I would have already used this by now.”
My dad utilized the same skills that he knew from working with violent patients at his main job to talk the guy into putting the gun away. He escorted him from the premises, and never saw another patient at home again.
My mom was pissed.”
“I’ve worked with a few, the most disturbing one was an ex military guy. He had served time in Iraq in the early 2000s, and he had killed in the line of duty. He always seemed a bit off, but the story he told me that was like, “holy hell he’s a sociopath” was when he told me about how he would do things like kill goats, because he could get away with that and some families there depend on livestock to survive.
The second was more of a “sterotypical” sociopath. He had been arrested for drug possession, and during the arrest attempt had stabbed himself a few times while trying to stab the arresting officers. He was very sharp, but intentionally choose the life of a drug dealer because it was violent. I don’t think he ever actually killed anyone, but he definitely abused people pretty horrifically. He dealt meth and enjoyed power tripping off messing with desperate addicts. He was also the only antisocial person I’ve ever met who had a weakened pain response. He once stabbed himself with a pen to prove to me he “didn’t feel pain”. And I mean like a legit, buried the pen in his flesh, blood everywhere kinda stab. Yeah….”
“While one cannot be diagnosed with Anti-social Personality Disorder (the disorder most-associated with what the layperson understands as sociopathy) until adulthood, Conduct Disorder is often the place-holder diagnosis given to children who meet similar criteria. While working as a Clinical Supervisor/Clinician at a mental health crisis/assessment facility, I had parents who brought in their 6 year old son. This kid was freaking adorable, soft-spoken and polite. When queried as to history, the parents remarked that among numerous incidents of animal cruelty/abuse.”
“Honestly, he made me feel scared and panicky to be in the same room. Part of being a therapist is you build a very strong client-therapist bond, and there’s a lot of empathy/openness in the room, so things can get quite intense and emotional (in a good way). With this guy I felt like a tiny trapped little animal in the room with a dangerous predator.
He had no remorse for his actions. He’d slip in remarks meant to impress/threaten, then look somewhat annoyed when I did not react (I was reacting inside). I do not fully recall his name/looks and wouldn’t on here anyway, but on the outside he looked totally normal and actually seemed kind of ok. But after talking to him for a while, there was this emptiness that I found quite disturbing.
He casually admitted to domestic abuse in the same way someone would admit they left the hall light on by accident… to me, in front of his partner!! He’d never brought it up before and, as a trainee I should NOT have been working with DV cases. They would be triaged and referred to someone with specialist experience. I can’t go into details, obviously, for confidentiality reasons… but it was a huge overreaction to an honest accident (could have happened to anyone) and he literally mentioned it in passing, and seemed to be more like’Oh for gods sake, this isn’t even worth mentioning, why did I bring this up, I’d rather be talking about myself’. He just didn’t care.
I remember just nodding and remained calm, whilst drawing a huge exclamation mark on my notes. I made it through the session somehow, then immediately told my supervisor and had him transferred to a different counsellor.
I’ve honestly never been so scared of another individual just from a’vibe’.”
“I’ve been a licensed therapist for going on three years now, but I’ve been seeing clients (with an Intern license) for about five years. The vast majority of my clients have been on probation or parole and have had a wide range of mental illnesses, including anti-social personality disorder (ASPD).
My mentor described folks with ASPD like this:”It’s in the eyes. They’ve got shark eyes: cold and predatory, like they’re staring right through you, looking for your weaknesses to exploit.” And, having worked with several people with that diagnosis (and adolescent precursor Conduct Disorder), it’s pretty damn accurate. People with ASPD are some of the most manipulative people around, and many of them enjoy it. Manipulating people is almost a game to them–well, a mini-game to indulge in while they work on whatever else they’re planning, even if it’s as simple as “present as normal.” And, let me tell you: they’re good at it. It’s incredibly difficult to out-play someone with the diagnosis at their own game because they’ve been playing it their entire lives. Since my clientele are court-ordered, most of the manipulation revolves around trying to cover up whatever else they’re doing (abusing their domestic partner, abusing substances, etc.). Some are more impulsive than others with the diagnosis, but they all have the shark eyes.”
9. Zero control
“Not a therapist, school psychologist. When talking to a student, he casually mentions how he keeps his parents _”in line” _by threatening to call ICE to have his mother (undocumented) deported. He doesn’t care about his family in the least, and they have zero control over him. His two siblings are typically developed and are terrified of him.”
“I work in a residential substance abuse program. I don’t take offense to most clients behaviors; they were in the midst of their addiction and they’re trying to get better for any number of motivators (self-referral, family, probation/parole mandated, etc.). I’ve worked with convicted murderers whom were remorseful and great to work with, so whatever, let’s do some work together. But I’ll speak of one person whom I believe to have Antisocial Personality Disorder:
After approximately 30 minutes talking to him during intake, I could tell how well he might be able to manipulate those he believes are “dumber” than him, and he stated as much. He mimicked my language, posture, he spoke eloquently, and was charismatic as all hell. But something was just off. I take note, and move on; needed more data. And as he continued in the program it became apparent. Everything was someone or something else’s fault. Failed relationships, his addiction and particular drugs of choice, his inability to hold jobs; no accountability or responsibility. He even blamed his brother for getting upset that he (my client) stabbed his brother. After my client had stolen his brother’s car in the dead of night and drove it in a ditch and abandoned it; then he lied about it and stabbed his brother for being “annoying”. He manipulated other clients and staff, and was damn good at it, except for a few of us who would call him out in group sessions or through behavioral contracts.
He was my individual client and during a session, I was challenging him because there were inconsistencies in something he shared. Then he finally came clean. He is HIV+ (I was aware of this). He contracted HIV by cheating on his partner or sharing a needle (he and the person he cheated with shared needles). He had discovered he was HIV+ prior to his partners return, as they were gone for an extended period of months. He got on treatment, and then… didn’t tell them at all. Still hadn’t at the time I stopped working with him, and I believe they are still together.
He completed treatment by going through the motions and is now out in the community. He is young. I have a strong feeling that at some point he will move to even more malicious acts, and I wouldn’t be surprised if he kills someone in the future.”
“This isn’t exactly what you were asking, but a relative of mine was given an unofficial diagnosis of ASPD when she was younger. At the time, the doctors told her family that they “didn’t like to officially diagnose someone that was under 18.”
As a child, she was extremely manipulative and could go from acting very _”normal” _to being stone cold in the space of a moment. Her parents forced her to go to therapy, but as soon as she became an adult, she stopped.
Her life now, as an adult, is pretty normal. She is still extremely manipulative but is also better at hiding it, so she comes off as charming. She works a normal job, though she usually changes jobs (by her own decision) every year or two. Her boyfriends seem to only last as long as they are useful for whatever reason. I don’t think she really has friends though.”
“Not a therapist, this happened to my Medical Psychology teacher (psychiatrist). Guy comes in. First time, has appointment. He is greeted by my teacher’s secretary. Doctor is with another patient, running 5 minutes late. Patient is upset because he was told he would go in at X time sharp. He sits down. After 5 minutes the patient gets fed up, stands up from the reception’s chair, goes to the secretary’s desk, grabs the 15 inch CRT computer monitor and crashes it into the secretary’s skull.
He leaves, calmly.
Secretary suffers several vertebral fractures along with a skull fracture.
I don’t know if the police caught the patient afterwards.”
13. Elementary School
“I work in an elementary school, I started there three years ago when the boy in question was in third grade. I knew something was off about him, but I didn’t have much interaction with him. Fast forward a year, he’s in fourth grade and since I work primarily in fourth and fifth grade, I’m having to deal with him a lot more. He mimics behaviors, has cold eyes and stares through people like he’s dissecting them. He’s very manipulative, but unfortunately (for him)/fortunately (for us) he’s so wrapped up in pleasing himself and getting what he wants, he’s not charming at all. Very manipulative, but lacking charm.
He was violent and would hit and kick other kids, which he was repeatedly written up for. Towards the end of fourth grade it came to a head. We were at recess playing a huge game with a lot of the fourth and fifth graders and he essentially got out. He freaked out and hit the kids who got him out. When he saw I was getting the behavior/incident report out, he ran at me.
I guess because I’m a 5’5″ female, and am overweight, he wasn’t expecting me to be as strong as I am, but he tried to tackle me, and instead I planted myself and he bounced off. He tried to punch me and the other teachers I was with called for back up. I just kept blocking his punches and kicks until the main disciplinary officer showed up. All the whole this kids is screaming details of how he’s going to torture me, told me he was going to use my intestines to strangle me.
Reports were written and he had to go to in-patient treatment. He’s back now, towards the end of fifth grade, and while he’s less violent now, and doesn’t threaten anyone, he’s still very manipulative. He scares me.”
“I work with kids. The boy was very charming and confident. Polite and well mannered. But I knew that he attempted to burn his sister and he liked to smear feces on the wall. He ran away a lot too. I asked my supervisor what would become of a kid like that. She said he was a sociopath in the making. Generally you don’t label kids as such but his behaviors for a 10 year old were extreme. Sad case. Sad and horrifying.”
15. Stick to academia
“Therapist here. I’ve had several clients that were a bit extra. The one that sticks out the most was during my work as an inpatient therapist where a borderline HIV + sex addicted client tried locking me in her room during rounds and offering “favors”. I haven’t done therapy in 2 months now and I think I’ll stick to academia for now.”
16. Zero remorse
“I work with adolescents mostly in group homes. This kid was particularly quiet and kept to themself. It was clear he didn’t understand social norms and rules. Would interject oddly and forcefully into conversations, had little to no theory of mind (understanding that others have thoughts), and would play games to understand how they should think during therapy. Anyhow, to make a long story short, they figured out how to mimic many emotions, graduated out of the program, and was transitioned back into the community. A few months after they’d left, their family was on the highway and this kid threw a dog out of the window. Zero compassion, zero remorse. They didn’t learn those well and it was apparent during the intake interview and subsequent therapy. They struggled and showed distress not knowing how to act and most of what they talked about after was how to not be discovered again.”